Scoliosis Lunch & Learn Webinar Blog

July 21, 2025

Topic: Topic: Lessons learned around the assessment and treatment of the adult patient with scoliosis – A conversation with two experts.

Navigating Adult Scoliosis: A Physical Therapist's Guide to Posture, Pain, and Realistic Goals

For many, scoliosis can begin in adolescence or come later in life. Whether you've lived with scoliosis for decades or have been newly diagnosed with degenerative scoliosis, navigating the world of treatment can be confusing. You might be asking: Is my scoliosis the source of my back pain? What can I do to stay active? Can anything be done without surgery?

These are common and important questions. Recently, a group of leading scoliosis practitioners, including Dr. Michael Vitale and Prachi Bakarania, DPT,  of Columbia  Orthopedics, Amy Sbilhi owner of Spine Academy Physical Therapy in Boston, and Alessandra Negrini, Assistant Rehabilitation Director at the Italian Scientific Spine Institute (ISICO), came together to discuss how they approach assessment and treatment of adult with pain and scoliosis. Their discussion moved beyond textbook measurements to deleve deeper into sharpening clinical reasoning in order to set achievable goals and empower patients. Here’s a look at their key insights.

Setting the Stage: Your Goals Matter Most

Before diving into any exercises, the first and most crucial step is understanding what you want to achieve. Amy emphasizes that treatment goals should be front and center, guiding every decision.

The primary goals of Physiotherapy Scoliosis-Specific Exercises (PSSE) aren't about chasing a perfectly straight spine on an x-ray. Instead, they are deeply functional:

• Reducing disability and improving daily function.
• Improving global balance, especially in the sagittal (front-to-back) plane.
• Decreasing the energy your body needs just to maintain its posture.
• Improving overall quality of life and decreasing pain.
• Providing education on joint protection, pacing, and ergonomics.
• Promoting a healthy, active lifestyle.

Amy shared her process of offering a free initial screening, where she simply listens to a patient's story. "I ask them to share their journey," she says. This conversation uncovers their motivations, previous treatments, and, most importantly, what they hope to accomplish. It also opens a practical discussion about commitment. As Amy wisely counsels her patients, if you're an accountant, "don't start during tax season." Successful therapy requires consistent 10 to 30 minutes of daily home practice, and setting yourself up for success means starting when you have the mental and physical space to do so.

A Key Clinical Clue: The Importance of Sagittal Balance

We also discussed the crucial role that the sagittal plane plays in this patient population. Next  Alessandra stressed the critical importance of accurately measuring and evaluating sagittal balance in your patient. A forward imbalance, where the trunk shifts ahead of the pelvis, is strongly correlated with pain, loss of function, and reduced quality of life in adults.

So how does this happen? With age, a natural process occurs:

1. The inward curve of the lower back (lordosis) tends to decrease.
2. The outward curve of the mid-back (kyphosis) tends to increase.
3. To compensate and keep the head up, the pelvis tilts backward.
4. Once the pelvis can't tilt anymore, the knees start to bend.
5. Eventually, these compensations are exhausted, and the body begins to fall forward.

Alessandra warns that therapists must look for early signs of this cascade, even in younger adults. A patient in their late 30s might not have pain but could already show a reduced lordosis and a backward pelvic tilt. "When the patient is still young, you can do a lot to prevent it," she urges. Intervening early to maintain sagittal balance can dramatically alter the trajectory of aging with scoliosis.

Beyond the Mat: Why Gravity Is Your Friend (and Foe)

A fascinating point raised by Alessandra is the common therapeutic pitfall of only training patients in gravity-reduced positions, like lying on their back or side. While these exercises can be useful for managing initial pain, they don't prepare the body for real life.

"Our life is lived not laying down," Prachi notes. "We live standing and sitting and bending and reaching and moving."

Research has shown that a spinal curve can measure, on average, around 9 to 11 degrees less when a person is lying down compared to when they are standing. Relying solely on supine exercises means you are never training the body to manage its load where it matters most: upright, against the force of gravity. The goal of PSSE is to teach the body how to actively contrast the pull of gravity and maintain a corrected posture throughout the day.

Smart Strengthening: Are Your Exercises Helping or Hurting?

Strength training is vital, but it must be thoughtful. Amy pointed out a common scenario: a well-intentioned patient goes to the gym and performs exercises that accidentally reinforce their scoliosis compensations.

She shared the example of a male patient whose personal trainer had him do:

• One-sided kettlebell carries: This caused his pelvis to push further into his existing thoracolumbar curve.
• Scapular strengthening (rowing): This flattened his upper back, worsening a compensatory pattern.
• Pec strengthening: This encouraged his already forward head posture.

The key takeaway? You must first learn how to achieve a more balanced posture, and *then* add load. The goal is to strengthen the body in a corrected alignment, not to build more strength on top of a dysfunctional foundation.

Tackling Tough Questions: A Practical Q&A

The webinar concluded with questions that many people with scoliosis face.

How should someone with both scoliosis and osteoporosis approach exercise?

Both experts agreed: you must load the bones to strengthen them, but you must do it safely. The first step is to prepare the body by establishing a better posture and control. Then, gradually introduce weight and impact, such as exercises with light weights or even jumping, once the patient can maintain their alignment and contrast their postural collapse. Weighted vests can be a tool, but it's often better to start with a lighter weight than is typically recommended online.

What about bracing for adults?

Dr. Vitale, a surgeon, offered a valuable perspective. While a brace can offer short-term support and pain relief, it should be used sparingly in adults. Over-reliance can weaken the core muscles, which is counterproductive to long-term stability. However, for a patient trying to avoid surgery, a brace might be a useful strategy for short periods to increase function and quality of life.

How do you help a patient who has trouble remembering their exercises?

Amy Siebel provided a fantastic toolkit for patient education:

• Ask about their learning style: Are they visual, auditory, or hands-on?
• Use technology: Apps and audio recordings of exercises can act as a "personal trainer at home."
• Provide physical reminders: Written handouts, a dedicated folder for exercises, and a weekly calendar to check off completed sessions can make a huge difference.

Conclusion: Your Path Forward

Living with adult scoliosis is not a passive "wait and see" game. It's an active process of understanding your unique body, setting meaningful goals, and working with knowledgeable professionals. The insights from these experts highlight a modern, functional, and empowering approach to physical therapy. It's about more than just the curve; it's about improving your function, managing pain, and confidently leading an active life. By focusing on realistic goals, sagittal balance, and smart, gravity-oriented strengthening, you can take control of your journey with scoliosis.